Patients in hospitals will be asked where they have lived for the last six months as part of a crackdown on health tourism. From Monday, hospitals will be obliged by law to identify and charge upfront any overseas patient who is not entitled to free NHS care.
The staff has been told to ask the question of every patient starting a new course of treatment either in a clinic or on a ward.
They are instructed ‘to avoid discrimination’ and quiz patients from all backgrounds and nationalities, even though the majority will be UK residents.
Meanwhile, patients at some hospitals are being told to bring driving licenses, passports, bank statements or energy bills to prove they are eligible for NHS care. Letters have gone out to them ahead of their appointments explaining they must ‘provide evidence’ of being ‘lawfully resident in the UK’.
Document checks are being carried out at 20 NHS trusts as part of a three-month pilot, which if deemed a success will be rolled out nationwide.
One of the trusts involved is King’s College Hospital in South London, where checks are being undertaken in the orthopedics and ophthalmology departments, two of its busiest.
Proof of identity includes a passport, driving license or ID card while proof of address can be a utility bill, bank statement or mortgage statement, provided it is dated within the last six months.
Those who have recently been living abroad will be told to provide documents proving they are entitled to free NHS care, such as an EHIC insurance card from an EU country.
Hospitals which fail to identify and bill overseas patients will be financially penalized, with money withheld from them by the local NHS trusts which control their budgets.
Announcing the rules, Mr. Hunt said: ‘We have to recognize that our cherished NHS is a national, not international, health service paid for by taxpayers.
Hospitals which fail to identify and bill overseas patients will be financially penalized, with money withheld from them by the local NHS trusts which control their budgets. Pictured: Health Secretary Jeremy Hunt
‘So at a time when we are working to make the most of every taxpayer pound that funds the NHS, we cannot afford to offer free healthcare to overseas visitors.
‘Just as we pay for healthcare when visiting other countries on holiday, it’s only fair that overseas visitors pay for their care to help protect NHS finances. I committed to helping trusts speed up the process, and that’s why from Monday, new laws will ask all organizations providing NHS treatment to ask if patients are eligible for free non-urgent treatment and to charge upfront those who aren’t.
‘Safety comes first – in an emergency, everyone will still have access to urgent care; no one will be denied that.
‘We are also mindful of our humanitarian duty and our duty to public health; some vulnerable groups won’t be subject to the rules and other services like A&E, primary care and care for those with infectious diseases, will remain free.
‘The changes will mean NHS staff can dedicate more of their time to actually treating patients rather than chasing money their organization is owed – and that money will go directly back into the NHS, so it can continue to provide world-class healthcare long into the future.’
Patients will not be routinely quizzed or charged upfront in A&E units or GP surgeries, as these are currently free for all.
But those attending maternity units will be questioned, although treatment will not be withheld if patients aren’t entitled to free NHS care and refuse to pay upfront. Guidelines sent to hospitals state that they should ask ‘baseline questions’ of ‘every single patient, in every single department’. This starts with, ‘Where have you lived in the last six months?’ If patients state the UK, no further action will be taken.
If they have been living overseas, staff must ask, ‘Do you have an EHIC or other documents to show that you’re entitled to free NHS care?’
Hospitals will be closely monitored by the Department of Health and NHS Improvement, the financial watchdog, to check they are identifying and charging an adequate number of overseas patients, based on their location and size.
If they are deemed to be falling short, they will have money withheld from Clinical Commissioning Groups, health trusts with control over local NHS budgets.
But Rachel Power, chief executive of the Patients Association, said: ‘Charging overseas patients is obviously not the right priority for the NHS at present.
‘Compared to the funding gap facing the NHS as a whole, the amount of money spent treating people who aren’t eligible for care is very small. New charges and checks will increase workloads, and no doubt oblige many people who are in fact eligible to present ID or other proof before they can access care. Another barrier to accessing services is not what patients need.’
Dr. Chaand Nagpaul, chairman of the British Medical Association’s Council, added: ‘It is important that those accessing NHS services are eligible to do so, especially at a time when the NHS is under intense pressure and struggling to cope with patient demand.
‘However, the current charging proposals lack clarity around how and when overseas patients should be charged which does run the risk of causing confusion and an additional administrative burden within NHS Trusts.
‘It is vital that patients do not face bureaucratic or financial obstacles that prevent acutely sick and vulnerable individuals from seeking necessary treatment.’